Helping the uninsured – can nurses make a difference?

One in six Americans was living in poverty in 2008, and that number has risen in 2009.

Many of these people have gone without—and continue to go without—health insurance.

We asked Jane Dellert, a nurse of 41 years who has treated uninsured children at low-cost clinics since the 1990s, what she thinks about the current healthcare crisis and what nurses can do to help the uninsured.

Scrubs: How did you get involved in working with the low-cost clinics?

Jane: For many years, the county Health Department’s division of Public Health Nursing has run a clinic for children without insurance to receive vaccinations and well child care. The clinic uses the Early and Periodic Screening and Developmental Testing plan used by Medicaid. In the 1990s, the public health nurses worked with PNPs employed by a local hospital in a clinic for low-income families to handle this well child clinic. I worked per diem in this clinic with my PNP colleagues. When my PNP colleagues went on to other work at the time that the hospital turned its clinic over to private providers, I was approached by the public health nurses to work as an independent contractor for the county well child clinic, and have done so ever since.

I have been a nurse for 41 years and a PNP for 23 years. As a PNP, I have worked in private practice and college health as well as in low-cost clinics. Currently, in addition to my faculty position at Seton Hall, I work one afternoon a month in this clinic for uninsured children, and two afternoons a week with a pediatric allergy and asthma specialist.

Scrubs: What are your hopes for the future of healthcare?

Jane: I see the fragmentation and confusion in our present patchwork of health insurance as the biggest barrier to providing the healthcare that children need, whether the children are covered by health insurance or not. Health insurance coverage can change at the drop of a hat, and families can be left scrambling to find ways to obtain the routine healthcare that children should have to remain healthy, never mind care for chronic conditions or catastrophic illness.

In addition, healthcare providers face constant confusion over what services will be reimbursed and what fees will actually be paid for services rendered, plus mountains of clerical work to submit claims for healthcare services given. Even a small healthcare practice must employ several people to deal with the issues of reimbursement in order to remain economically solvent and therefore available to their clients.

In the clinic for children with no health insurance, I see the consequences of losing insurance, not qualifying for government insurance (Medicaid) or not being able to afford individual health insurance policies. In private practice, I see the struggle to keep insurance, the confusion around keeping access to services when insurance changes and the tremendous burden of dealing with many different health insurers’ systems.

I hope to see fragmentation, confusion and gaps in services eliminated, and that all providers of health services (physicians, nurse practitioners, physician’s assistants, pharmacists, dentists, etc.) will be able to efficiently and fairly receive appropriate compensation for the services rendered. And I hope that opportunities for healthcare fraud will be significantly curtailed.

Scrubs: What would you recommend other nurses do to help patients navigate the system?

Jane: Nurses often know which patients are facing problems accessing appropriate healthcare because patients will share these troubles with nurses. Often, these people end up in emergency departments because they don’t know where else to go, or they have neglected a health problem for so long that they’re truly in dire straits, in need of hospital care.

Nurses can help close some gaps by being aware of what services are already available in their locales but may be in need of personnel. Nurses can further help by approaching policy makers (in government locally and at a distance, and in hospital systems) about gaps in accessibility of health services, with ideas for new programs.

The well child clinic in which I do some of my clinical work came about because of the efforts of public health nurses.

Scrubs: What are the most rewarding moments of your work?

Jane: Two things are especially rewarding. One is seeing that children are protected against preventable illnesses, which leads to better quality of life. Many people have forgotten or never knew of the terrible toll that can follow infection with polio, measles, chickenpox, etc. The second very rewarding aspect is having time to teach parents about health and child development. The time is not much, but it may be just enough to enhance parenting skills and knowledge for people who don’t have a lot of other resources for this.Jane Cerruti Dellert, PNP, is a professor at Seton Hall University’s College of Nursing in South Orange, N.J. She works with children for a few hours approximately once a month in a clinic for children without health insurance, which is supported by county taxes and run by the local public health nurses.